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,: <br />; <br /> ; I <br />�' i <br />� I � <br /> �� <br /> ��_ <br /> Date y �^ Publlc Wo�ks Permil s � � 37� I�, <br /> Application For eiaU.o�o�,_ ��-r��5 � II <br /> �U '�' ��� �■ l��L� V��� '� FubnclYorksFcc I <br /> v � � rotai Feo S <br /> Lc.s ApOL Fec PaiJ S <br /> Balance Dw $ 4 v' �'O <br /> Priiit or Type Only <br /> �l�y�r )�f�C --������ <br /> i <br /> ��O�rF-� L:an��� �� � es S"Z�7- l�`f-�` � l�S� /��inv,����e c� <br /> Owner Ma��ing Address City Zip Phone <br /> \ <br /> ��� � <br /> Appfcant Maiiirg�ddress City Zip Phnne <br /> Describe Prcposed Work � ��� <br /> — � f � <br /> Prolect Address(if known) � _ /�G�� � —� �� 7� �:', S�. �� <br /> AttaCh lour(4) copies of plans(or proposed work- Draw ic scale and note the followinc� as applicable: s�� <br /> • Properry L��es • Centerline of street � <br /> • Dutline c^.�: dimensions of all existin9 and • Indicate North <br /> proposed�� «icturee on the lot • Show any proposed grading changes <br /> i Ezisting zr;! proposed utilities • Show measurements � � <br /> ������ <br /> DO NOT WRITE BELOW THIS LlNE � <br /> PERMIT CONJITIONS <br /> � 'r t. All calls lor nspection shall be made 24 hrs. in advance- phone 259•881 5. . <br /> 2. All work sha'I be perlormed in accordance with this permit and current City of Evn,rett Design and Cons�ruc�ion � � <br /> Standards and Specifications <br /> 3. Call Locatior l,,ider9round Service 48 hrs. before ycu dig.TOLL FREE NUMBER 1-800�424-,`i555. � <br /> 5� �9,%r/ �Ti'a���������c o,v Ti< <c�- s�:��� �,-wr <br /> 1/�?f?(Jc:% /�c� ...�cG�i'C'L�2'l.�iit�L� COiS` C:�i%i/ .�Q'"d��:�°'d'cK' � <br /> �Pd.✓-or=�. <br /> > > � � � .,.,,_ � <br /> JL- /�U�F G C'Gt�li�_Sr [ c . "4 ��� G'c l�T:�'T- L i/��-';�� � <br /> %C) <br /> Ti/E 1��'a��-'v GE Sf/S��� � <br /> � <br /> �. S/!/'✓ � GUi�'i3S' A.e?E NE��' 9 �/i's7�Ji»eC-'E� , ��� C��li,9,adr' � <br /> T� 7.-iEm L(IiGL �nF'G{G'.,cf �t�Fa�,aCE'i�C�%'T���/ ���E <br /> ����oL i LA i✓r � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> _ Thc undersigned owneUapplicant hereby agrees�o hold and save harm� <br /> lesu the City of Everett from any and all claims for damages, costs, <br /> . � �� exp?nses, or causes of action that may arise because ot installatinn <br /> �- �t� �:J���� j��� c�`� �nd main�enance of the impwvemen� or other riyht-oFway use h�reto <br /> Approved (or Consiruction % Dn�e °PP�'ed for and fu�iher agrees to remove same upon notice Irom ihe <br /> � Ci�•�.ind to replace public prope�ty damaped thereby. <br /> 1 7.Zz' �/'(/lvil'N/La_J' <br /> FINAL INSf'ECTION �a� I��'�.'� ' — <br /> Approved as Censtructed SiynaWre of Applican� Da�o <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERM'��� tAUST FiF STARTED WITHIN <br /> � 3200C�darStreet 1d0 D,�YS OF DATE PERtv;1T IS ISSU�D AND THEREAFTER IS TO <br /> Everelt,WA 98201 I 6E DILIGe�VTLY PURSUED TO COMPLETION. THIS PERMIT �"FlY BE <br /> Phone: 259�8815 ��'���!CI:LLP.L' i3v TI IG CITY UPON ANY STOPPAGF OF WORK ON THIS <br /> � I'H�)JF ;T O1�[R ')0 DAYS DURATION. <br />